Utilization of Telemedicine to Treat Hepatitis C at a Medication-Assisted Opioid Treatment Program

Issue: START Treatment & Recovery Centers is an outpatient medication-assisted opioid treatment program that also provides primary medical care. Approximately half of our 3000 largely minority patients are infected with hepatitis C virus (HCV). Very few have accepted HCV treatment to date.  Based on studies showing that co-location of substance abuse treatment with other co-occurring conditions results in improved outcomes for both conditions, we developed a protocol to treat HCV utilizing telemedicine.

Description: It had to be determined whether patients would be interested in on-site treatment. We surveyed 320 patients to determine knowledge level of HCV; asking whether they were receptive to attending educational sessions as a prelude to treatment. The response was overwhelmingly positive, providing impetus to move forward.  We have provided HCV education to all treatment staff and 114 patients.  Fifty patients are HCV infected; of which 23 have had on-site linkage to specialized medical services and evaluation for treatment.  Telemedicine was instrumental in providing these services and evaluations efficiently.

Lessons Learned: Compliance with referral to medical specialists in conventional health care settings is poor. Reasons include fears or doubts, lack of knowledge or interest, and physical limitations. Telemedicine is a simple, cost-effective way to assure timely HCV care, i.e. the hepatologist comes to our clinics (via telemedicine), instead of patients being referred outside.  Preliminary indications are that our approach has been well-received by patients. 

Recommendations: The process of implementing the infrastructure to provide the educational training and telemedicine capabilities presented a number of challenges involving patients, providers, technology, and reimbursement that we have successfully navigated to create a viable model for telemedicine-based delivery of HCV services in a substance use facility.  We expect outcomes (HCV cure rates) to far exceed currently achieved levels for this hard to reach population that is at the epicenter of the HCV epidemic.